Cymbalta vs. Effexor: Which Should You Choose?
Medically reviewed by Mary Choy, PharmDMedically reviewed by Mary Choy, PharmDCymbalta is the brand name for duloxetine, and Effexor XR contains the active drug venlafaxine. These are prescription drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). They are used to treat different forms of depression and anxiety.Although they are in the same drug class, they are quite different. They are approved by the Food and Drug Administration (FDA) for different indications in various age groups, dosage forms, and dosing regimens.This article will highlight the similarities and differences between Cymbalta and Effexor ER so that you can choose the most suitable option.
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Cymbalta vs. Effexor XR: Key DifferencesCymbalta and Effexor XR are selective serotonin and norepinephrine reuptake inhibitors (SNRIs). They work to increase the amounts of serotonin and norepinephrine in the brain that helps maintain balance.The tables below give an insight into the key differences and similarities between Cymbalta and Effexor XR.
Cymbalta
Effexor XR
Drug class
SNRIs
SNRIs
Generic drug
Duloxetine
Venlafaxine
Dosage form
Delayed-release capsules
Extended-Release Capsules
Strength
20 milligrams (mg), 30 mg, or 60 mg
37.5 mg, 75 mg, or 150 mg
Approved for use in children
Yes
No
Availability
By prescription only
By prescription only
Other brands
Drizalma Sprinkle
None
Generic alternatives available
Yes
Yes
UsesCymbalta and Effexor XR are FDA-approved for different indications. They are also used off-label (not FDA-approved) for many other conditions. Below is a comparison of their uses.
Indications
Cymbalta
Effexor XR
Major depressive disorder (MDD)
Adults
Adults
Generalized anxiety disorder (GAD)
Adults and children aged 7 years and older
Adults
Social anxiety disorder (SAD)
X
Adults
Panic disorder
X
Adults
Diabetic peripheral neuropathic pain
Adults
X
Fibromyalgia
Adults and children age 13 years and older
X
Chronic musculoskeletal pain
Adults
X
Urinary incontinence
Off-label use in adult women
X
Hot flashes in people who have experienced menopause (stopping of the menstrual cycle) and are taking breast cancer medication
X
Off-label use
Effexor XR is not approved for use in children.Which Is More Effective?Only a few clinical studies directly compare duloxetine and venlafaxine. Each person's response to each medicine may vary.According to a systematic review of several studies, both medications are effective for the short-term treatment of major depressive disorder.Another older study (from 2008) showed that duloxetine and venlafaxine are equally effective and tolerable for treating generalized anxiety disorders.When prescribing, a healthcare provider considers factors such as age, other medical conditions or drugs you take, and your response to treatment.Side Effects: Which Is More Tolerable?Most antidepressants, including Cymbalta and Effexor XR, are generally safe, but all these drugs carry FDA boxed warnings (the strictest warnings for prescription medications). Cymbalta and Effexor XR may increase the risk of suicidal thoughts and behavior in children and young adults. The risk is higher at the start of therapy or when changing doses. People taking these drugs should be monitored closely for clinical worsening (changes that decline, are not temporary, and go beyond what is natural for the disease) and new signs of suicidal thoughts and behaviors.These drugs also show some other side effects.Common Side EffectsThe most common side effects include:ConstipationDecreased sexual driveDizzinessDry mouthIncreased sweatingLoss of appetiteNauseaSleepinessSevere Side EffectsSome severe side effects of Cymbalta and Effexor XR that may need medical attention include:Abnormal bleedingBlood pressure changesDiscontinuation syndrome (problems due to discontinuing a medicine at once)Hyponatremia (low sodium levels in the blood)Manic episodesSeizures or convulsionsSerotonin syndrome, which can cause a range of symptoms that include but are not limited to agitation, confusion, tremors, muscle stiffness, and a fast heart rateSevere skin reactionsVision problems, including blurrinessEffexor XR may also cause lung problems. Symptoms may include difficulty breathing, cough, or chest discomfort. Tell your healthcare provider right away if you have any of these symptoms.Other severe side effects related specifically to Cymbalta include liver damage and urinary retention.Risk of Liver FailureSevere liver problems, sometimes fatal, have been reported in people treated with Cymbalta. How Cymbalta causes liver injury is not well known.Check in with your healthcare provider if you have the following symptoms:Upper right abdominal painUrine that is darkWhite or clay-colored stoolsYellowing of the skin and whites of the eyesUse of Cymbalta with heavy alcohol intake has been associated with severe liver injury.Serotonin SyndromeSerotonin syndrome is a potentially life-threatening drug reaction. It causes the overproduction of neurotransmitters (a chemical messenger that transmits serotonin between nerve cells in the nervous system) by some nerve cells.Serotonin syndrome most often occurs due to drug-drug interaction (interactions between drugs) that affect the body's level of serotonin. The medicines cause too much serotonin release or accumulation in the brain area.Serotonin syndrome is more likely to occur when you first start taking or increasing the dose of the medicine.Both Cymbalta and Effexor can cause serotonin syndrome when used with drugs including:Amphetamines (central nervous system stimulants)Buspirone (treats anxiety)Fentanyl (synthetic opioid drug)Lithium (treats mania associated with bipolar disorder)Saint-John's-wort (plant that may have antidepressant properties)Tramadol (reduces pain)Tricyclic antidepressants (manage MDD)Triptans (treat migraines)Tryptophan (treats depression)Symptoms occur within minutes to a few hours of taking medicines that can and may include:Abnormal eye movementsAgitation or restlessnessDiarrheaHallucinationsHigh blood pressure (hypertension)Increased body temperatureLoss of coordinationNauseaOveractive reflexesRapid changes in blood pressureTachycardia (fast heartbeat)VomitingSymptoms of serotonin syndrome and their severity may vary in different people.Other PrecautionsAs an additional precaution, tell your healthcare provider about all your medical conditions before taking Cymbalta and Effexor XR, including:Bleeding problemsFamily history of suicide, bipolar disorder, depression, or maniaGlaucoma (pressure in the eye)Heart problemsHigh blood pressureHigh cholesterol or high triglyceridesKidney or liver problemsLow sodium levels in the bloodLung problemsSeizures or convulsionsStrokeIf you are pregnant or plan to become pregnant, be aware that both drugs may increase the risk of complications in the newborn after birth, particularly if taken during the last months of pregnancy. Talk to your healthcare provider about the risks of taking Cymbalta or Effexor XR during pregnancy.Cymbalta and Effexor XR pass into the breast milk. Talk to your healthcare provider about whether alternative ways to feed your baby are necessary while taking these drugs.Never stop taking these drugs without first talking to a healthcare provider. Stopping suddenly can cause other symptoms. Your healthcare provider will gradually lower the dose before stopping altogether.Do Any Other Drugs Interact With Cymbalta or Effexor XR?Drug-drug interactions need to be addressed before taking any prescription drug. Like all medicines, Cymbalta and Effexor XR may interact with some other drugs. Here are a few examples that should not be taken with Cymbalta and Effexor XR:Amphetamines such as Adderall (amphetamine and dextroamphetamine), Dexedrine (dextroamphetamine) and Desoxyn (methamphetamine)Anticoagulants (blood thinners) such as Jantoven (warfarin)Antidepressants such as Elavil (amitriptyline), Anafranil (clomipramine), and Norpramin (desipramine)Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen) and Aleve (naproxen)BuspironeCipro (ciprofloxacin)Diuretics (also known as water pills)FentanylLithiumMedications for anxiety, high blood pressure, mental illness, pain, and nauseaMedications for irregular heartbeat, such as Pacerone (amiodarone)Medications for migraine headaches such as almotriptan, Relpax (eletriptan), and Frova (frovatriptan)Monoamine oxidase inhibitors (MAOIs) such as Marplan (isocarboxazid), Zyvox (linezolid), and methylene blue (Cymbalta or Effexor XR should not be taken within 14 days of these drugs; if you stop taking Cymbata or Effexor XR, wait at least five days before you start to take an MAOI)Saint-John's-wortSedativesSelective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Luvox (fluvoxamine), and Paxil (paroxetine)Sleeping pillsTagamet (cimetidine)Theo-24 (theophylline)TramadolThis may not be a complete list of drugs that interact with these drugs. Discuss with your healthcare prescriber all other drugs that you take before taking Cymbalta and Effexor XR.SummaryCymbalta and Effexor XR are antidepressant drugs called SNRIs. Both drugs are used for the treatment of chronic depression and anxiety disorders (for example, general or social).Cymbalta also treats fibromyalgia and musculoskeletal or diabetic neuropathy (nerve pain). Unlike Effexor XR, it is also approved for use in children. They have similar side effects and drug interactions and are equally effective. Read the original article on Verywell Health.
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